Melanoma is one of the most common cancers in Australian and United States populations. In the United States, 76,380 new cases of invasive melanoma are estimated to be diagnosed in 2016. In 2016, it is estimated that 10,130 people die of melanoma. The annual cost of treating melanoma is estimated as $3.3 billion. Therefore, besides being fatal, melanoma can affect multiple stages of a societal fabric.
While melanoma can be a fatal disease, it can be treated fully when detected early, by for example, an excisional biopsy. Typically, early detection of melanoma in a skin mole or other lesion is assessed by the presence/absence of certain features in the mole or other lesion. These examinations are usually formed as defined protocols used by health care professionals. There exist several such protocols such as, for example, “ABCD Rule”, “Menzies Rule”, “3 point checklist”, etc. Common features across these different protocols can include the presence of certain “colors” (brown, black, red, etc.) and/or patterns (networks, globules, etc.). When examined under dermoscopy or other clinical imagery, health care professionals look for signatures and assign a score to the mole or other lesion. The decision to perform a biopsy occurs if the score exceeds a predefined threshold, the value of which may vary depending on rules and/or protocols.
Though the use of dermoscopy or other clinical imagery enhances sensitivity of disease detection, diagnosis of a skin lesion is not trivial, even for health care professionals. However, as the understanding of skin lesion physiology grew over time, researchers found new insights for early detection of melanoma. One of these insights is the concept of “ugly duckling”, which was introduced in Grob J J et al., “The ‘Ugly Duckling’ Sign: Identification Of The Common Characteristics Of Nevi In An Individual As A Basis For Melanoma Screening.” Arch Dermatol 1998; 134(1):103-104 The core idea behind the ugly duckling concept is that each mole or lesion should be examined not by itself, but with other moles or lesions in the surrounding area. For example, the presence or absence of a signature could be considered significant in detecting melanoma if the same signature is respectively absent or present in the surrounding moles or lesions.
Evidence is emerging that the ugly duckling method is very effective to identify potentially melanocytic lesions. Studies among dermatologists, nurses and non-clinicians have indicated that practitioners believe that ugly duckling methodology can be very useful to identify potential melanoma lesions.